经皮肾镜取石术术中肾盂内压与镜鞘比的关系  

Relation between renal pelvic pressure and ratio of endoscope-sheath diameter during percutaneous nephrolithotomy

作　　者：谢国海[1] 刘万樟 方立 严泽军[1] 朱佳奇 刘冠琳[1] 郑重[1] 程跃[1] Xie GuoHai;Liu Wanzhang;Fang Li;Yan Zejun;Zhu Jiaqi;Liu Guanlin;Zheng Zhong;Cheng Yue(Department of Urology,Ningbo No.1 Hospital,Ningbo 315010,China)

机构地区：[1]宁波市第一医院泌尿肾病中心泌尿外科,315010 [2]宁波大学医学院

出　　处：《中华泌尿外科杂志》2018年第9期703-706,共4页Chinese Journal of Urology

摘　　要：目的探讨经皮肾镜取石术（PCNL）的镜鞘比对肾盂内压的影响。方法2016年9月至2017年6月采用24个成年家猪离体肾脏模拟PCNL的穿刺、扩张操作。分别穿刺建立F12、F14、F163种大小通道，配合可视经皮肾镜（F8）和输尿管镜（F6／7．5、F8／9．8），共8组镜鞘组合（除外F8／9．8-F12组合），经皮肾镜和输尿管镜的工作通道均置入200μm钬激光光纤。分别在50、100、150、200、250、300、350、400、450、500cmH2O（1cmH2O=0．098kPa）灌注压（P0）下测量不同镜鞘组合的。肾盂内压（Pr），每组通道扩张3个肾脏，并重复测量3次。结果F8-F12、F6／7．5-F12、F8-F14、F6／7．5-F14、f18／9．8-F14、F8-F16、F6／7．5-F16、F8／9．8-F16镜鞘组合的镜鞘比分别为0．67、0．92、0．58、0．79、0．87、0．50、0．68、0．75；灌注压一肾盂内压线性方程分别为P，=0．026P0-1．533、P。=0．112P0-5．001、P，=0．010P01．067、P，=0．020P01．000、P，=0．144P0＋20。933、P，=0，005P0l。067、P，=0．009P0＋0．533、Pt=0．020P0＋2．200；最大肾盂内压分别为（12．2±0．5）、（51．2-4-0．9）、（6．2．4-0．5）、（10．84-0．5）、（84．7±1．2）、（2．84-0．3）、（5．1±0．3）、（12．6±0．6）cmH2O。灌注压一定时，镜鞘比与。肾盂内压成正比；镜鞘比一定时，灌注压与肾盂内压成正比。镜鞘比〈0．80的组合，肾盂内压均〈40cmH2O。镜鞘比≥0．80的组合（F6／7．5-F12、F8／9．8-F14组合），要维持肾盂内压〈40cmH2O，须保持灌注压分别为〈401．7cmH20和〈132．4cmH20。结论行PCNL时，为保持安全的肾盂内压，应采用镜鞘比〈0．80的镜鞘组合，以及适当的灌注压。Objective To observe the influence of ratio of endoscope-sheath diameter on renal pelvic pressure during PCNL. Methods The model of 24 isolated adult porcine kidneys were used to imitate percutaneous nephrolithotomy from September 2016 to June 2017. Each tract was established （ F12, F14 and F16）. Three kinds of endoseopes （ F8 all-seeing needle pereutaneous nephroscope, F6/7.5 and F8/ 9.8 rigid ureteroscope）, input a 200μm laser, were adopted. There were 8 combinations, and 3 kidneys were used for each one. Renal pelvic pressure was measured 3 times repeatedly in every combination with steady irrigation （50,100,150,200,250,300,350,400,450,500 cmH2O）. Results The linear equations, ratios of endoscope-sheath diameter and highest renal pelvic pressures for each combination were： F8-F12, Pr = 0. 026P0 - 1. 533,0.67,12.2 ±0.54 ;F6/7.5-F12, Pr = 0.112P0 -5. 001,0.92,51.2 -0.93 ;F8-F14, P, = 0. 010 P0＋ 1. 067,0.58,6.2 ± O. 48 ; F6/7.5 -F14, Pr =0. 020P0 ＋ 1. 000,0.79,10.8 ± 0.46 ; F8/9.8-F14, Pr =0. 144P0 ＋20. 933,0.87,84.7 ± 1.17 ;F8-F16 ,Pr =0. O05P0 ＋ 1. 067,0.50,2.8 ± 0. 34 ; F6/7.5-F16, Pr = 0. 009P0＋ 0. 533,0.68,5. 1 ± 0.32 ; F8/9.8-F16, Pr = 0. 020P0 ＋ 2. 200, O. 75,12.6 ± 0.56. The combinations of F6/7.5-F12 and F8/9. 8-F14 might lead to a high renal pelvic pressure without proper irrigation （ 〈401.7 cmH2O for F6/7.5-F12; 〈 132.4 emH2O for F8/9.8-F14）. Conclusion In order to keep a safe pressure, a proper ratio of endoscope-sheath diameter （ 〈 0.80） and appropriate irrigation must be considered.

关 键 词：经皮肾镜取石术 肾盂压力 通道大小 镜鞘比 

分 类 号：R699.2[医药卫生—泌尿科学]